What is Osteoporosis? | What causes Osteoporosis? | How is Osteoporosis diagnosed? | How can Osteoporosis be treated?


How can Osteoporosis be treated?

Until recently, treatment of osteoporosis was limited to hormone replacement (estrogen in women and testosterone in men) plus physical exercise and a high calcium intake. In the past several years we have seen an explosion of new chemicals and modalities used to treat this extremely common disease. Thanks to the efforts of the National Osteoporosis Foundation (NOF) and the development of accurate bone density measurements, there has been immense interest and progress in the recognition of and treatment of the disease.

Hormone Replacement Therapy (HRT) is still the mainstay of osteoporosis treatment, but there are several new estrogen compounds and progesterone compounds that greatly expand the acceptance of hormone therapy. There is one new estrogen compound, Evista, (and several more like it are in the works) which acts like estrogen on bone but has no estrogen effect on the uterus. It seems to have a protective effect against breast cancer as well and this may have some heart protective effect as well. This should allay the fears of many women about hormones and breast cancer. For men, testerone is available as an injection, a patch, and soon as an under the tongue dissolvable tablet. Oral testosterone tablets are too toxic to the liver to be used for the treatment of male osteoporosis. Estrogen has been recommended as treatment for osteoporosis in almost all women because it not only protects against and treats osteoporosis, it also protects against hardening of the heart arteries (coronary arteriosclerosis) and other blood vessel conditions which can lead to heart attacks and strokes. (For women who cannot or do not want to take estrogen, there are other methods of protecting against heart attack and stroke which are as effective if not more so then estrogen.) Estrogen is available as tablets, skin patches, creams, vaginal tablets, and "natural sweet potato based" phyto-estrogens that for some women, is as potent as "premarin" and "prempro" and easier for them to take. The same is true for progesterone.

Calcitonin, a bone related hormone, is also very effective. Miacalcin is available as a nasal spray or as a subcutaneous self-injection, and has the advantage of reducing the pain of osteoporosis faster than most other treatments. Osteoporosis can be painful with or without fractures. This pain relief is as effective as narcotics and is much longer lasting - when the pain goes away, it usually stays away.

Calcium supplementation has been a mainstay of the treatment of osteoporosis for many years. Unfortunately very few physicians, clinics, or centers monitor the use and effectiveness of calcium supplements adequately. Calcium supplementation must be monitored and measured to determine if the amount taken a sufficient or in excess, which can lead to such problems as kidney stones. Additionally Vitamin D status must be measured and monitored to make the most of calcium supplements.

Exercise has been shown to prevent and sometimes even reverse osteoporosis. Weight lifting and/or power walking (3 miles in 45 minutes or less, four times per week) have been shown to be very effective in this regard. Weight lifting three times per week has also been shown to be very effective in women and men as old as 85.

A class of chemicals called biphosphonates is very effective in preventing and reversing osteoporosis. Didronel was the first of these chemicals. Fosamax is a very well known and well publicized biphosphonate, but it causes stomach and esophagus problems in many people, and the need to take it first thing in the morning on an empty stomach with 2 large glases of water is a turnoff for some and difficult to comply with. There are several other biphosphonates which are easier to take than Fosamax, and more effective. Some are tablets that can be taken twice a week and some can be given intravenously once every 3 months.

How is the effectiveness and response to treatment monitored?
Bone density determinations will show where the bone density is, but they cannot tell where the bone density is going, or the response to treatment. Values can be determined one and two years apart to determine if the bones are responding to treatment. This is not adequate for most people with significant osteoporosis. Urine bone markers are substances released into the urine as the bone resorption process progresses. The absolute amount of the substances in the urine can help the doctor decide if the bone resorption process has been slowed to the point that bone formation is faster. These bone markers are measured in the urine at six week intervals to determine the effectiveness of any bone directed treatment. The markers are so sensitive that they can even detect fractures too small to see in X-rays. Blood levels of parathyroid hormone, bone specific alkaline phosphatase, and vitamin D levels are used to determine the effectiveness and adequacy of nutrient intake to be sure that as the process of bone resorption is altered, the calcium, phosphorous, and magnesium intakes are optimal. Calcium excretion as measured in an early morning urine is used to determine the presence of a calcium overload. The same urine can be used for the determination of the bone markers. 24 hour urine determinations cannot be used because many foods will interfere with the determination of these substances in the urine. An overnight fast is sufficient to eliminate all dietary related factors that might otherwise invalidate the results. Home>>